Peter Piot, ebola, HIV and global health’s evolution opens ASTMH

Dr. Peter Piot gives the keynote address at the 62nd annual American Society of Tropical Medicine and Hygiene meeting.

If you’ve read Peter Piot’s memoir, No Time To Lose, or heard him speak, you might know some of the story that the co-discoverer of the ebola virus and founding head of UNAIDS told as the American Society of Tropical Medicine and Hygiene’s 62nd annual meeting opened Wednesday night in Washington, DC.

But perhaps the most striking aspect of the story he told on this occasion was that among the audience of roughly 2800 in the crowded ballroom were listeners, now active in global health efforts, who had not yet been born, back when the events he described began to unfold. It was a time that is part of history now, before AIDS, before treatment for HIV, before an epidemic and a response that changed the way health is viewed.

Piot was in his last years of medical school, in the early 1970s, when his professors advised there was no future in infectious diseases. Vaccines, they said, had put an end to all that. “Fortunately,” Piot added, “I didn’t listen to any of them.”

Flash forward, then to one day when he was 27 years old, and opened a package from Kinshasa containing two vials, one broken, one not, both containing a new virus they identified under a microscope and named “ebola.”

“I learned a few things from that outbreak, my first global health experience,” he said. “I looked around and saw how poverty was driving diseases.”

He learned the power of collaboration but also its challenges, and, with the revelation that a hospital reusing its short supply of syringes was actively transmitting the virus, he learned “that good intentions can be dangerous.”

Still, that was no preparation for what happened next, when, as he put it, “AIDS hit us out of the blue.”

The lessons from that were longer in coming and harder won but they too were lasting ones in his telling: the critical role of an evidence-based response, of human rights recognition, of unified action, and of activism by the people whose lives were at stake.

“The AIDS response broke a number of taboos,” he said. “It disrupted the divide between prevention and treatment.” In the course of that, he added, it brought recognition of health as a human right, and consigned “simplistic solutions to the dustbin of history.”

For all of that, talk of eradication (of polio), elimination (of malaria), and “ending” (as in “the end of AIDS is in sight”) ignores the obstacles that remain, he said. Those include complacency, funding, resistance to drugs (and insecticides, in the case of malaria), empty drug pipelines and the years before an HIV vaccine can be expected, and the power that still remains in the hands of wealthy nations when epidemics ravage poor ones.

“I’m quite skeptical the end is in sight,” he said. “It should be, one day it will be.”

But first, the world that has come to embrace global health will have to become a more equitable one, he said.

“You can question if a country can be called sovereign,” he said, “when the lives of hundreds of millions of people depend on a vote in the U.S. Congress.”

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